枕下经颈-颈静脉突入路达颈静脉孔区的显微解剖研究

目的 研究一期切除颈静脉孔区复杂性肿瘤的微创手术人路。方法 选择经10％福尔马林固定成人头颈标本10具，显微镜下模拟枕下经颈一颈静脉突人路的手术操作，逐层显露颈静脉孔区，研究该区显微解剖特征及显露范围。结果 该人路直接沿乙状窦、颈内静脉的移行方向显露颈静脉孔区结构，其中后颅窝可经枕下显露，颞下窝藉寰椎与下颌升支间的自然间隙显露。通过切除颈静脉突和迷路下骨质分别自后、外、下和上方显露颈静脉孔。头侧直肌是界定颞下窝结构和枕下三角内结构的确切标志。后组颅神经，交感千和颈内动、静脉行于其前方，椎动脉寰椎上段及其周围的静脉丛行于其后方。结论 枕下经颈一颈静脉突人路可自多个方向充分显露颈静脉孔区结构，且可保护面神经、迷路、耳蜗和椎动脉等结构免受不必要的损伤。

Microsurgical anatomy of the suboccipital transcervicojugular approach to the jugular foramen region

Objective To describe a minimally invasive approach to resection of extensive jugular foramen tumors at one-stage. Methods With the aid of surgical microscope, the microsurgical anatomy and the exposure of the suboccipital-transcervicojugular approaches were investigated in 10 cadaveric head-neck specimens of adults embalmed with formalin. Results The posterior fossa can be reached through suboccipital approach, the structures in infratmporal fossa can be exposed directely through the corridor between the atlas and mandibular ramus. The jugular foramen can be exposed after removal of the mastoid process and the petrous bone under the labyrinth superiorly and by resection of jugular process posteriorly. The rectus capitis lateteralis is the most important landermark, posterior to it, the vertebral artery and its accompanying venous complex within the suboccipital triangle can be identified, anterior to it are carotid artery, internal jugular vein, lower cranial nerves and sympathetic trunk. Conclusion The suboccipital-transcervicojugular approach can expose the jugular foramen region sufficiently, and offer advantages in preventing labyrinth,cochlea, facial nerve and vertebral artery from unecessary injury.